St. Vincent Clay Hospital, Inc.
Organization Active NPI Critical Access Hospital · Brazil, IN
NPI 1467525634 · NPPES record last updated May 5, 2015
Key facts
- NPI
- 1467525634
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 060050461 (IN)
- Legal business name
- ST. VINCENT CLAY HOSPITAL, INC.
- Practice address
- 1206 E National Ave
Brazil, IN 47834-2718 - Phone
- (812) 442-2500
- Fax
- (812) 442-2605
- NPI assigned
- Nov 16, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- ST. VINCENT CLAY HOSPITAL, INC.
Authorized official
- Name
- Jerry Laue
- Title
- Administrator
- Phone
- (812) 442-2602
Owners & managing parties with NPI records 1
-
Michael T Emmons, DO
Other NPIs with the same Medicare PAC ID 1
Related certifications (CCN) 1
Facilities with the same owner 166
Affiliated clinicians 4
-
David Lawrence Fryman, M.D.
-
Ismail Qattash, M.D.
-
Muhammad R. Toor, M.D., DABIM
-
Frank Anton Zwerner, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Hospital certification: CCN 15Z309
- Legal name
- ST. VINCENT CLAY HOSPITAL, INC.
- Doing business as
- ASCENSION ST VINCENT CLAY
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 1206 E National Ave
Brazil, IN 47834-2718
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Jacob Steve Baker |
Corporate Director |
Jul 1, 2024 | |
| Cynthia Dawn Adams |
Corporate Director |
Jul 1, 2025 | |
| Carlyle Floyd |
Corporate Director |
Jul 1, 2025 | |
| Floyd Grubb |
Corporate Director |
Jul 1, 2025 | |
| Michael Todd Emmons |
Corporate Director |
Jun 30, 2025 | |
| Dana M Muntz |
Corporate Director |
Jul 1, 2025 | |
| Allison Taylor |
Corporate Director |
Jun 30, 2025 | |
| Robin Ludlow |
Corporate Director |
Jul 1, 2025 | |
| Todd Jones |
Corporate Director |
Jul 1, 2025 | |
| Loraine Brown |
Corporate Director |
Jul 1, 2025 | |
| Jamie Webster |
Corporate Officer |
Jul 1, 2024 | |
| W-2 Managing Employee |
Jul 1, 2024 | ||
| Ascension Health |
Operational/Managerial Control | Jul 10, 2000 | |
| St Vincent Health Inc |
Operational/Managerial Control | Jul 10, 2000 | 100% |
| Ryan Penrod |
Corporate Director |
Jul 1, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080109000842 | IN | Part a Provider - Critical Access Hospital | 0143119859 | Practice locations: Brazil, IN |
National Provider Directory
- Part of
- St Vincent Clay Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 060050461 | IN | Yes |
Addresses
Primary practice location
1206 E National Ave
Brazil, IN 47834-2718
Mailing address
1206 E National Ave
Brazil, IN 47834-2718
Phone (812) 442-2500
Other names
- Swing Bed
Other providers in Brazil, IN
- Sally J Sidman
- Christina E. Smith
- Jamie Beth Smith
- James David Spiller
- St. Vincent Clay Hospital, Inc
- St. Vincent Medical Group, Inc.
- St. Vincent Medical Group, Inc.
- Gary Edward Staadt
- James Ernest Stephens
- Jennifer Lynn Swearingen
All providers in Brazil, IN · Critical Access Hospital in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 5, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.